Addressing the Mental Health Needs of THP+ Participants

1. Addressing the Mental Health Needs of THP+ Participants Tracy Davis, ASW Shawna Lauer, MFT Rebecca Hathorn, ASW

2. About our programs • Supported Housing Program (THP+), Bay Area Youth Centers • Scattered site model providing individualized support to youth • Social workers assist in creating goals around relationships and self-awareness, education, employment, mental health and housing and community development • Foster Youth Development Program, WestCoast Children’s Clinic • Flexible, community-based, wraparound mental health services ~ a relational approach

3. Healthy Development vs. Disrupted Attachment • NURTURING & CONSISTENCY = confidence, joy, problem solving skills, playfulness & curiosity • TRAUMA + LACK of NURTURING & CONSISTENCY = interruption of the development of initiative, autonomy, self-esteem, social awareness, ability to learn, physical health, emotion regulation & interpersonal relatedness

4. Relationship problems • Emotion regulation difficulties • Substance abuse • Irritability • Sleep difficulties • Hopelessness & helplessness • “Spacing out” • Oppositional behavior & aggression • Academic problems • High risk behaviors • Problems with daily living activities • Paranoia, bizarre behaviors, delusions, hallucinations Signs and Symptoms of Mental Health Problems in Adolescents & Young Adults

5. Identity development • Separation from family of origin • Exploring educational and vocational opportunities & goals • Desiring and achieving responsible social behavior Developmental Tasks of Adolescents & Young Adults

6. Accessing Mental Health Services • Former foster youth are entitled to FULL SCOPE Medi-Cal until their 21st birthday • After the age of 21… • Build a relationship with a Medi-Cal specialist, or Transition Age Youth Liaison, who can support the young person to navigate the system

7. To Make a Referral • Call Medi-Cal to get a list of providers in your area • Contact those providers and ask questions • What services do you provide? • What is the referral process? Waitlist? • What are grounds for discontinuing services? • What model/approach do you use? • Use your own judgment. Would you feel comfortable with this person? How do you imagine the youth might respond to this provider and his/her approach?

8. Encouraging Mental Health Services Building the youth’s interest and willingness to participate in therapy is a process…

9. Educate Yourself • Seek out trainings for yourself and your staff • Familiarity = Comfortability • Trainings should be culturally relevant and specific to this age group. Recommended topics include: • Trauma & Attachment • Depression in adolescents • Anxiety, PTSD, Complex PTSD • Neuropsychology and brain development • Substance Abuse ~ Harm reduction & Motivational interviewing • Crisis de-escalation

10. “I don’t need therapy, I’m not crazy!!” • Resistance & ambivalence about therapy is normal and understandable • Cultural implications • Growing up in a system • Past experiences with mental health services

11. Speak to the Ambivalence • “A part of you might really want help with this…” • “Another part of you might be worried about…” • What other people might think • What your family might say or think • That people think you’re crazy • That you might have to talk about things you don’t want to

12. Normalize • Symptoms & behaviors are a normal, adaptable, and functional response to an abnormal situation • “This really worked for you before. But, now I wonder if it might get in your way sometimes?” • “Everyone needs help now and then” • “It seems like the more support and different perspectives you can get, the better.”

13. Wouldn’t it be nice to talk to someone who… • Is unbiased and neutral • Can offer an outside perspective • Keeps things confidential • Doesn’t have the authority to…

14. Curiosity, A Powerful Tool • Help the youth to become curious about his/her behaviors and symptoms • Wondering aloud • Naming the symptoms/patterns • Externalize • De-stigmatize ~ good? Bad? Or just is?

15. Use your relationship • ‘I know a guy/gal…” • “I know that it’s really hard for you to trust people, it took a long time for you to trust me. I imagine it’s hard to think about opening up to someone new.” • “I really think this might be good for you…” • “Do you know how much those people charge? I’d love the chance to go for free!”

16. Speak to the hopeful part… • We don’t have to start with the biggest problem here… • What is resolvable? • What matters to you? • What are you willing to let others help you with?

17. Empower the youth to take action on his/her own behalf • Therapy is voluntary • “You can interview the therapist and decide for yourself.” • “You can go at your own pace, quit if you need to…” • “What kind of person would be a good fit for you?” • “Let’s think about what questions you might want to ask.” • “What have your past experiences in therapy been like?” • “What would you want to be different?” • “Maybe I can help you find someone who would be a better fit.”

18. Fight, Flight, or Freeze • Therapy can stir up anxiety and anxiety can trigger the desire to… • Fight • “I hate my therapist” • Flee • “I’m never going back there” • Freeze • “I don’t know when my next appointment is” • “Oh, I forgot”

19. Opening a dialogue • “You might want to quit sometimes, or get mad at the person you’re working with. Let’s talk about it if you start to feel that way.” • “It seems like maybe you’re feeling overwhelmed (scared). That’s understandable.” • “Wow. Therapy is hard, huh.” • Encourage the youth to bring these problems back to the provider and let him/her know what the he/she needs or wants • Remind the youth that this is a safe place to try new ways of resolving interpersonal problems • A corrective emotional experience

20. Effective collaborations ~ How do we get there? • Define roles from the beginning and be ready to redefine as needed • Build upon each other’s strengths, resources, and expertise

21. Effective collaborations ~ How do we get there? • Communicate, communicate, communicate! • Be responsive to phone calls and follow through on tasks • Schedule regular face to face meetings • Define how confidentiality will be handled and share this with every member of the team, most importantly, with the client • Open communication amongst team members • Respecting the client’s privacy • How to describe this to the youth

22. Effective collaborations ~ How do we get there? • Problems and differences of opinion will arise ~ work it out • Be prepared for splitting • Check yourself. Are you feeling territorial? Is your ego getting in the way? • Work with the youth to help him/her work through difficulties that arise in his/her relationship with other team members

23. “It takes a village…” • For us too! • Have fun. Share successes and funny stories • CELEBRATE when things go well • Support each other when they don’t • Be honest when you’re feeling hopeless or frustrated • Attend trainings and events together and get to know your “team” outside of the office

24. An Example…

25. These symptoms were many years in the making and will take many years to heal… Experiencing long-term relationships that are consistent, predictable, and safe…a valuable and necessary intervention to improve the emotional functioning of Transition Aged Youth